Epidemiology and Infection

Original Papers

Q fever

A Q fever outbreak in a psychiatric care institution in The Netherlands

R. P. M. KOENEa1a2 c1, B. SCHIMMERa2a3, H. RENSENa4, M. BIESHEUVELa5, A. DE BRUINa6, A. LOHUISa1, A. HORREVORTSa7, F. VERDUYN LUNELa8, C. E. DELSINGa9 and J. L. A. HAUTVASTa1a2

a1 Municipal Health Service Region Nijmegen, The Netherlands

a2 Academic Collaborative Center Public Health AMPHI, Department of Public Health, Radboud University Nijmegen Medical Centre, The Netherlands

a3 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), The Netherlands

a4 GGZ Location Nijmeegse Baan, Nijmegen, The Netherlands

a5 Food and Consumer Product Safety Authority (VWA), The Netherlands

a6 Laboratory for Zoonoses and Environmental Microbiology, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), The Netherlands

a7 Department of Medical Microbiology and Infectious diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

a8 Department of Microbiology, Radboud University Nijmegen Medical Centre, The Netherlands

a9 Department of Internal Medicine and Infectious Diseases, Radboud University Nijmegen Medical Centre, The Netherlands

SUMMARY

In May 2008 the Nijmegen Municipal Health Service (MHS) was informed about an outbreak of atypical pneumonia in three in-patients of a long-term psychiatric institution. The patients had been hospitalized and had laboratory confirmation of acute Q fever infection. The MHS started active case finding among in-patients, employees of and visitors to the institution. In a small meadow on the institution premises a flock of sheep was present. One of the lambs in the flock had been abandoned by its mother and cuddled by the in-patients. Samples were taken of the flock. Forty-five clinical cases were identified in employees, in-patients and visitors; 28 were laboratory confirmed as Q fever. Laboratory screening of pregnant women and persons with valvular heart disease resulted in one confirmed Q fever case in a pregnant woman. Of 27 samples from animals, seven were positive and 15 suspect for Coxiella burnetii infection. This outbreak of Q fever in a unique psychiatric setting pointed to a small flock of sheep with newborn lambs as the most likely source of exposure. Care institutions that have vulnerable residents and keep flocks of sheep should be careful to take adequate hygienic measures during delivery of lambs and handling of birth products.

(Accepted January 06 2010)

(Online publication February 09 2010)

Correspondence:

c1 Author for correspondence: R. P. M. Koene, P.O. Box 1120, 6501 BC Nijmegen, The Netherlands. (Email: rkoene@ggd-nijmegen.nl)

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